WASHINGTON – Diseases that could be cured today with a trip to the doctor’s or a short hospital stay were deadly business — literally — in 1910.
Life expectancy in Maryland was 40 years back then, when people routinely died of afflictions like diarrhea, whooping cough and tetanus.
Rapid advances in medicine have since checked those diseases and nearly doubled life expectancy in the process. But while some killers are under control, others like cancer are afflicting more people than ever before.
And new ones like AIDS have appeared.
It’s an example of what Gert Brieger, a medical historian at Johns Hopkins University, calls a “mirage of health”: “We never get rid of all diseases. If you get rid of some, others will replace it.”
But the medical advances were no mirage. The progress in controlling disease in the 20th century was reflected in mortality rates: in 1997, the rate in Maryland was almost half of what it used to be in 1910. And life expectancy nearly doubled — from 39 years in 1910 to 75.9 years in 1997.
The century saw the discovery of antibiotics that made many infectious diseases like whooping cough curable. Whooping cough, which killed nearly 23 of every 100,000 Marylanders in 1910, had just one victim in 1997.
Felix Kaufman, president of the Maryland chapter of the American Academy of Pediatrics, said the biggest advance in the field of medicine in the 20th century, even bigger than the miracle medicines, was the ability to identify disease.
Deaths due to influenza and pneumonia dropped from 164 per 100,000 people in 1910 to 28.6 per 100,000 in 1997. And immunization almost completely eliminated diseases like polio and tetanus. The state has not had a case of wild virus polio for 10 years now, Kaufman said.
Heart disease, which edged out tuberculosis as the state’s top killer in the 1920s, dropped rapidly from a peak in 1950. But its casualties still remained high — almost twice as many deaths as there were at the start of the century.
But while Marylanders at the start of the century had to fear polio and whooping cough, there was no such thing as AIDS to worry about. AIDS appeared in the 1980s and soon replaced other sexually transmitted diseases, like syphilis that are almost under control today.
“People don’t die of syphilis, but the moral connotations are the same,” Brieger said.
When Dr. Marion Friedman gave up his Baltimore medical practice in the mid-1980s, after 40 years of medicine, he said he had never treated a single HIV patient. “I never used gloves to draw blood from a patient,” he said.
But by 1990, AIDS had established itself as the state’s 10th-biggest killer. By 1997, it had moved into ninth place, and among certain racial and age groups in the state it is the top killer. Currently, Maryland has the fourth- highest rate of AIDS cases in the country.
And other diseases that had declined over the decades have returned — some, ironically, as an indirect result of medical advances in other areas.
Diabetes, for example, declined after the discovery of insulin. But it began to rise again in the 1950s and today kills many more people than it did at the start of the century.
“Diabetes is particularly a paradox,” said Brieger. “When it became possible to control diabetes in expecting mothers, leading to safe deliveries, there actually was an increase in the gene pool of diabetics because the disease can be hereditary.”
Tuberculosis also is beginning to reappear after declining rapidly since the discovery of antibiotics. Strains of tuberculosis that are resistant to those antibiotics are now beginning to emerge, Brieger said. In 1997, Maryland had 18 tuberculosis deaths.
There also are some diseases that we will never quite get rid of. For instance, “there is no permanent vaccine for tetanus so it will always be around,” Kaufman said.
Cancer and heart disease persist because of lifestyle factors that contribute greatly to their incidence. Poor eating habits, lack of exercise and high rates of smoking had all been responsible for a rise in Maryland’s cancer cases, said Lynn Khoo, director of the Maryland Cancer Registry.
“If we were to get rid of all lifestyle-related cancers, we would be left with just 40 percent of the cases we have today,” she said.
The fact that people are living longer also increased cancer cases “because age is a high-risk factor for cancer,” she said.
Other lifestyle changes led to a rise in other kinds of casualties. In 1910, for instance, there were almost no motor vehicle deaths.
“The only accidents that happened then were railroad and horse-carriage accidents,” Brieger said.
But in the 1950s, motor vehicle accidents emerged among the top killers in the state. Casualty rates have declined steadily since, from 20.4 deaths per 100,000 people in 1990 to 12.5 deaths per 100,000 in 1997.
But the overall outlook is positive. As we enter a new century, we will be “healthier and happier,” Brieger said.
And so will our kids. Better prenatal care for women have reduced infant mortality rates over the century, and the ability to better control diseases among children has meant healthier children.
“About 30 to 40 years ago, we were admitting four to five times more children to hospitals today than we do today,” Brieger said.
Technology had also made it possible for infants born less than 1,500 grams (3.3 pounds) to survive, he said. “In the ’60s, when I trained, they had a very small chance.”
But despite all the breakthroughs of the last century, and those expected in the century to come, most experts agree with Brieger that there will always be something around to keep the medical community busy.
“Doctors will always be in business,” said Friedman.